Rotator cuff tendonitis in arm lymphedema

Rotator cuff tendonitis in lymphedema: a retrospective case series.

Herrera JE, Stubblefield MD.

New York-Presbyterian Hospital and Hospitals of Columbia and Cornell, New York, USA.

OBJECTIVES:

To report rotator cuff tendonitis as a complication of lymphedema and to discuss the possible etiology and treatment options.

DESIGN:

Retrospective review of 8 cases.

SETTING:

University hospital outpatient clinic.

PARTICIPANTS:

A total of 8 breast cancer patients with a history of lymphedema and ipsilateral shoulder pain.

INTERVENTION:

Patients with lymphedema and ipsilateral shoulder pain were diagnosed with rotator cuff tendonitis if all of the following 3 tests were positive: supraspinatus test, Neers impingement test, and Hawkins impingement test. Patients diagnosed with rotator cuff tendonitis were prescribed a nonsteroidal anti-inflammatory drug (NSAID) and physical therapy (PT).

MAIN OUTCOME MEASURES:

Improvement in symptoms of shoulder pain at a 4- to 6-week follow-up, as measured by visual analog scale (VAS).

RESULTS:

Seven of 8 patients reported a subjective decrease in their symptoms of shoulder pain at a 4- to 6-week follow-up. The average improvement in shoulder pain as measured by VAS was a 4.5-point decrease from the original pain score given. One of 8 patients had a full-thickness supraspinatus tendon tear and required additional decongestive therapy and PT to obtain relief of symptoms.

CONCLUSIONS:

Rotator cuff tendonitis is a complication of lymphedema caused by internal derangement of tendon fibers, which may be subject to impingement, functional overload, and intrinsic tendinopathy. Conservative treatment with NSAIDs and PT is a safe and effective treatment.PMID: 15605330

[PubMed - indexed for MEDLINE]

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Shoulder arthroplasty in patients with prior mastectomy for breast cancer.

Andrews LR, Cofield RH, O'Driscoll SW.

Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA.

Twenty women, all of whom had undergone mastectomy for breast cancer and 11 of whom had undergone radiation therapy, underwent shoulder arthroplasty. Two of these patients subsequently underwent resection arthroplasty for delayed infection and uncontrollable instability. Seventeen patients were available for follow-up, which averaged 4.6 years (range, 23 months to 13 years). There was significant improvement in pain (P < .0001), with no pain in 8, slight pain in 7, occasional moderate pain in 1, and moderate pain in 1 of the patients. A significant improvement in active motion occurred only in external rotation. Active elevation increased 7 degrees, from 92 degrees to 99 degrees; external rotation increased 17 degrees, from 25 degrees to 42 degrees; and internal rotation increased 1 level, to L3. All patients were pleased with their results. Complications were frequent. Apart from the 2 patients who underwent reoperation, 5 patients with preoperative lymphedema experienced exacerbation of their edema and 2 others developed new lymphedema. The edema returned to prearthroplasty levels or resolved in all patients by 5 months. In addition, antecubital vein thrombosis occurred in 1 patient, delayed long head of biceps rupture in 2 patients, and late rotator cuff tearing in 3 patients. In carefully selected patients, shoulder arthroplasty can be effective in pain reduction, but little increase in range of motion should be expected. Complications (often involving soft tissues) are frequent. New or increased arm edema can occur; however, edema resolved or returned to prearthroplasty levels in our patients.PMID: 11075321

[PubMed - indexed for MEDLINE]